Trapped fourth ventricle—treatment options and the role of open posterior fenestration in the surgical management

Tyagi, Gaurav; Singh, Prashant; Bhat, Dhanajaya I.; Shukla, Dhaval; Pruthi, Nupur; Devi, Bhagavatula Indira

doi:10.1007/s00701-020-04352-3

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…These complications were mainly related to the misplacement of the catheter, and even if the techniques have evolved, options include, nowadays, the following: open fenestration through a suboccipital craniotomy, fourth-ventricular shunting, and minimally invasive procedures including endoscopic stenting and fenestration. These techniques are associated with complications in 42% of cases (6)(7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

Case Report: A Rare Case of Fourth Ventricle to Spinal Subarachnoid Space Shunt Migration: Surgical Pearl and Literature Review

Serratrice¹,

Faddoul²,

Tarabay³

et al. 2021

Front. Surg.

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Background: In the event of syringomyelia communicating with the fourth ventricle, a fourth ventricle to cervical subarachnoid space shunting could be proposed.Case Report: In this review article, we describe the case of a 40-year-old woman who had a previously implanted fourth ventricle to spinal subarachnoid space shunt for the treatment of syringomyelia in the context of Chiari syndrome. The catheter migrated intradurally to the lumbosacral space, but in the absence of neurological repercussions, we decided to leave it in place.Conclusions: To the best of our knowledge, this is the first case described in the literature review of a catheter migration in the subarachnoid space from occipitocervical to lumbosacral level.

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Section: Discussionmentioning

confidence: 99%

Case Report: A Rare Case of Fourth Ventricle to Spinal Subarachnoid Space Shunt Migration: Surgical Pearl and Literature Review

Serratrice¹,

Faddoul²,

Tarabay³

et al. 2021

Front. Surg.

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“…Popularization of this technique then follows, until the era of neuro-endoscopy evolved in cranial surgery, aiming at restoring the patency of the 4 th ventricular outlets in a simple physiological way instead of adding more hardware with possible hardware complications. Although this seems to be more physiological, still literature is lacking sufficient data to ensure the superiority of 1 technique over the other, and all attempts at treating TFV were small series of reports tailored to individual cases (17,18) .…”

Section: Historymentioning

confidence: 99%

“…Other authors claimed shunting the fourth ventricle was the less invasive and more effective approach. It is common to use a combination of these techniques to have good results (18) . Multiple treatment modalities have been described in the literature, with superiority for endoscopic procedures (24)(25)(26) .…”

Section: Modalities Of Treatmentmentioning

confidence: 99%

“…Y connectors have been advocated by many authors when a fourth ventricular catheter is a plan (13) . They claimed that this may also prevent any pressure difference between supra and infratentorial ventricular systems, being connected to the same valve, thus decreasing the possibility of headache that may occur by changes in the position of the body (18) . 4 th ventricular catheter as a treatment option for trapped 4 th ventricle, although seems to be old fashion and carries a lot of hardware complications, sometimes it represents the only treatment option for trapped 4 th ventricle and maybe the endpoint after the failure of other modalities such as aqueductal stenting and 4 th ventriculocisternostomy.…”

Section: Th Ventricular Catheter and Y Connectormentioning

confidence: 99%

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Evaluation of Connecting a Fourth Ventricular Catheter with Y Connector to a Previous Ventriculoperitoneal Shunt, as a Treatment Option for Patients with Symptomatic Trapped Fourth Ventricle

Eltantawy

Elmeleigy

Arab

2023

The Egyptian Journal of Hospital Medicine

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Background: Trapped fourth ventricle (TFV) is a rare clinico-pathological syndrome, usually resulting from inflammatory conditions (post-infective and post-hemorrhagic) that may present with serious brain stem compression manifestations. Many treatment modalities have been described with varying degrees of success. Objectives: To evaluate our results in managing the trapped 4 th ventricle by inserting 4 th ventricular catheter and connecting it to the previously implanted ventriculoperitoneal (VP) shunt via Y connector. Patients and Methods: A total number of 12 cases with TFV were diagnosed and treated surgically between 2014 and 2021 by a fourth ventricular catheter and connection to the pre-existing shunt via a Y-connector. Preoperative clinical and radiological findings were reported. Postoperative improvement was evaluated during a mean follow-up of 4.3 years. Postoperative complications were reported Results: 12 patients (6 males and 6 females), with a mean age of 3.3 years diagnosed with trapped fourth ventricles were included. All patients had previous VP shunts. Headache, vomiting, abnormal movement, gait disturbance, and nystagmus were the common symptoms. Trapped fourth ventricle was post-infectious in 6 (50%) patients, posthemorrhagic in 4 (33.3%) patients, and congenital in 2 (16.7%) patients. 6 (50%) patients had preoperative slit lateral ventricles and 4 (33.3%) had multiloculated hydrocephalus. Postoperatively 10 (83.3%) patients had clinical improvement while 2 (16.7%) remained as preoperative. All patients had a decrease in the 4 th ventricular size. Complications of surgery were minor. Conclusion: Fourth ventricular shunting with a Y connector is a valuable and effective modality of treatment in TFV, especially when other methods fail or in specific complex pathological situations, with fewer complications.

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“…The offending pathophysiologic mechanism is attributed to the inflammation of the ependymal lining of the ventricle which is a consequence of the underlying causative pathological process. The ultimate result of that pathological process could be the obstruction of the outlets of the fourth ventricle (foramina of Luschka and Magendie), which ultimately leads to the development of this type of obstructive hydrocephalus 1,2 . In the vast majority of cases, these patients already harbor a ventriculoperitoneal shunt due to a pre-existing hydrocephalus referring to the supratentorial ventricular compartment.…”

Section: Introductionmentioning

confidence: 99%

Comparison of treatment modalities regarding the entity of the trapped fourth ventricle: A 20-year retrospective analysis of our clinical experience

Panagopoulos¹,

Stranjalis²,

Gavra³

et al. 2022

MRAJ

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Introduction: The entity of the trapped fourth ventricle represents a clinical challenge, as it is a rare entity associated with a wide spectrum of underlying pathologic conditions and the proposed treatment options are restricted and frequently associated with complications and unfavorable long-term outcome. The majority of the affected individuals report a medical history of previous ventriculo-peritoneal shunt infection, as well as a precipitating factor for the entrapment (central nervous system infection, intraventricular hemorrhage, trauma). They come to clinical attention due to symptomatology attributed to mass effect that is exerted by the ballooned fourth ventricle on the brainstem and cerebellum. Materials and Methods: We present our results, extracted from data derived from our medical center 20 years surgical experience and relevant outcomes in 120 pediatric patients diagnosed and managed with entrapped fourth ventricle. They were treated either with fourth ventricle-peritoneal shunt insertion or with an endoscopic approach. The relative efficacy of both techniques was recorded one year and five years after the initial operation and the data underwent statistical analysis. All patients who failed the initial therapeutic option were managed again with the aforementioned techniques, and their long-term results were recorded. Conclusions: We recorded that after one year of follow-up, there were no significant differences in outcome when these two techniques were compared. However, when the results of five-year follow-up were compared between two groups, there was superiority, regarding the functional outcome, of the procedure involving the insertion of a fourth ventricular-peritoneal shunt. The outcome of patients that underwent a salvage procedure of any type did not seem to be different after a one-year follow-up period, being unable to verify the superiority of one technique over the other. However, there seems to be a superiority of the shunt procedure over the endoscopic technique regarding the functional outcome of these patients, five years after their second operation. Nevertheless, these results are only indicative and our data are insufficient to establish a statistical level of significance, probably due to the restricted number of patients that were incorporated in our survey.

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Trapped fourth ventricle—treatment options and the role of open posterior fenestration in the surgical management

Cited by 8 publications

References 25 publications

Case Report: A Rare Case of Fourth Ventricle to Spinal Subarachnoid Space Shunt Migration: Surgical Pearl and Literature Review

Case Report: A Rare Case of Fourth Ventricle to Spinal Subarachnoid Space Shunt Migration: Surgical Pearl and Literature Review

Evaluation of Connecting a Fourth Ventricular Catheter with Y Connector to a Previous Ventriculoperitoneal Shunt, as a Treatment Option for Patients with Symptomatic Trapped Fourth Ventricle

Comparison of treatment modalities regarding the entity of the trapped fourth ventricle: A 20-year retrospective analysis of our clinical experience

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